Healthcare Provider Details

I. General information

NPI: 1457476590
Provider Name (Legal Business Name): LAURIE HELTZEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 W BETHANY HOME RD STE 100
PHOENIX AZ
85015-2458
US

IV. Provider business mailing address

300 W CLARENDON AVE STE 350
PHOENIX AZ
85013-3497
US

V. Phone/Fax

Practice location:
  • Phone: 602-274-4484
  • Fax: 602-287-9406
Mailing address:
  • Phone: 602-274-4484
  • Fax: 602-287-9406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3046
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: